This is an interesting one. My partner (who, incidentally, had a caesarean) remembers the first 24 hours as being amongst the worst. After receiving bucket loads of attention for the 9 months of her pregnancy – and then even more throughout a 70 hour labour! – it came as a huge shock when her daughter was pulled out, whisked off and poor mum was left all alone for the next several hours wondering “what next”.

So, realistically, what should you expect for you and your baby just after the birth? You’ve attended the pre-natal yoga classes and antenatal classes, had your massages, learnt breathing techniques in preparation for the birth of your child, but what happens after that? To help you understand what happens in this critical point of time, we have gathered thoughts from some of the leading obstetricians to hear what they think mum (and baby) should be prepared for.

What happens immediately after the baby is born?

Upon delivery, attendant staff will wrap the newborn in warm towels after the umbilical cord is cut. They then assess the newborn for breathing and colour, and clear the baby’s airway and provide stimulation or assistance for breathing if needed. Once babies are determined to be warm, pink and breathing comfortably, they are usually presented to their mothers for cuddling and even initiation of breast-feeding. The mother will quickly monitored for any excessive bleeding and her blood pressure should be taken.

What happens when the pain relief wears off?

Many mothers will be administered some form of pain relief when going through labour and subsequently, they should be prepared for the time when that wears off and they start feeling the pain (yes, sorry, you can’t get away from the pain). After a caesarean section delivery, mothers will feel pain at the area of the wound immediately after surgery. Those under epidural anaesthesia will feel the pain gradually increase, but this pain can be anticipated and adequate pain killers can be given. The location of the pain is also different; one is in front of the tummy and the other, on the bum. If you have had a C-section delivery, your movements are rather restricted. With a normal delivery, sitting can pose a challenge.

When should you start breastfeeding?

You may or may not be aware that breast milk production in new mums can actually take over two days before it is available to the child. That doesn’t mean you shouldn’t breast feed immediately, you just need to be aware that some babies may need supplemental milk in the first 24 to 48 hours. Generally speaking, most babies born at full term do quite well without any supplemental milk while waiting for mother’s milk to be produced. Whatever the case, doctors believe it is good to let babies breast feed soon after delivery to a) stimulate production of the milk, as well as to b) allow early bonding.

What health checks will be done in the first 24 hours?

When your baby is born the paediatrician will perform the first examination him/her in hospital. This will involve a head-to-toe physical assessment of your baby’s health. A hearing screen will typically be included as will an injection of vitamin K, to prevent deficiency and easy bruising. Vaccinations against Hepatitis B and Tuberculosis are given before your baby goes home. Another test you can expect is the newborn metabolic screen, which uses a few drops of baby’s blood to screen for a panel of severe, genetic metabolic diseases. That’s why you may see the paediatrician taking some early blood samples.

What should mum eat and drink after the birth?

Don’t worry, I not going to say the placenta! We’ll leave that stuff to folk lore and cult behaviour, thank you very much! For mothers who have had a natural birth, try light but wholesome foods. You will need to replenish your natural energy supplies so lots fruit and vegetables with plenty of fluids and vitamins. For mums who have gone under general anaesthesia, they are always advised to go slow on the food and take fluids for the first 12 hours (for fear of vomiting). Those that have had a caesarean under epidural do much better in this aspect and they are able to eat around 12 hours after surgery. But they still should not eat too much too quickly as the intestines will complain and cause the tummy to become bloated.

When does post-natal depression take hold?

The first thing that may upset the mother is their lack of milk supply. As we’ve already pointed out above, it can take a few days for the milk to arrive so straight away this can make mum feel depressed and unable to properly care for their child. Often, relatives make it worse by contributing more ridiculous solutions to confuse the new mothers rather than recognising that this is quite natural and will rectify itself in due course.

My baby looks discoloured! Why?

Jaundice is a common occurrence in newborn babies, especially those of Asian descent. It manifests as a yellow tinge in the skin or whites of the eyes, and typically reaches its peak on the third to fifth day. It is generally monitored and is not harmful to babies unless very high levels are reached. Treatment usually leads to improvement within 24 to 48 hours. If the baby is red, with bruising discolouration, that’s perfectly normal… you’d look battered if you’d just gone through the same exercise! In any case, the paediatrician will be closely monitoring baby’s health so unless he sees anything abnormal, don’t worry.

How do I handle visitors?

OK, you know there will be plenty of visitors. For you and baby, it is best to try and limit these to smaller parties and for short periods. Here’s a good tip that my mum shared with me; if there are chores that need doing, get your visitors doing them; it will help you and will also make them feel important and needed. It’s a good way to keep everyone engaged and happy. It probably goes without saying, but adults and children with colds and illnesses should not be visiting.

Ovulation; the ins and outs:

When ovulation takes place, a female’s ovaries release an egg for fertilization. This is the most important part of a woman’s menstrual cycle and takes place once a month and two weeks before the woman’s period. For most women ovulation occurs on the 14th day of their 28 day cycle. Of course, the cycles may vary from 20 to 32 days.

Hormones:

A female body has certain hormones which are released by various parts of the body. These hormones influence the ovulation. The brain releases hormones which stimulate the development of eggs in the ovaries. Estrogen and progesterone are two hormones which can be found in the ovaries. These hormones help release eggs during ovulation. The interaction of these hormones causes ovulation and menstruation.

Ovaries (Eggs):

The ovaries of a woman store eggs. These eggs are present at birth and can range from 900.000 to 1 million eggs. However, the number of these eggs declines to about 400.000 eggs by the time a woman starts menstruating. When women hit menopause in their mid to late fifties, they will stop ovulating and menstruating, thus being unable to conceive children.

The process of ovulating:

The ovulation cycle of a woman is determined by her hormone levels. These hormone levels send messages to the body. The hypothalamus, the pituitary gland and the ovaries are responsible for triggering ovulation. Ovulation, however, can skip a month if the messages sent from and to your body are intercepted.

How to know if you’re ovulating:

If you are trying to conceive knowing when you are ovulating may come in handy. By recognizing the symptoms of ovulation you will be able to predict the best time for you and your partner to have intercourse. The list of symptoms are as follows:

• Cramps in the abdominal region
• Rise in body temperature between 0.4 and 0.6 degrees
• Sensitive breasts
• change in firmness of cervix

How to control your ovulation:

Women wishing to conceive who have an irregular ovulation may find it difficult to conceive. To help regulate your ovulation you could consider changing a few things in your life.

• Avoid stress
• Eat proper meals
• Try to regulate your weight
• Exercise, but not too much

Ovulation and menstruation are beautiful processes of nature. If you are having a hard time conceiving try watching your ovulation to recognize the right time to have intercourse. If need be, consult a doctor.

The Menstrual Cycle
The menstrual cycle is approximately a 28-day cycle, which is divided into four overlapping phases; follicular phase, ovulation, luteal phase and menstruation. Of these four phases, ovulation is the most important with regard to fertility.

Ovulation
It is during this short phase, an ova (egg) is recruited and released into the fallopian tubes. The “window of opportunity” after ovulation is only 12-24 hrs. Now this doesn’t mean that one has to have intercourse only after ovulation to conceive. The sperm can remain viable within the female reproductive tract for 24-72 hrs. Intercourse, even three days before ovulation, can result in fertilisation. By having intercourse around the time of ovulation, the chance of becoming pregnant is greatly increased.

A woman’s ovulatory period can be predicted by measuring the basal body temperature. The basal body temperature increases by 1 degree, around the time of ovulation. Alternatively the ovulation date can be estimated by subtracting 14 days from the start of the last menstrual period (LMP). For example if the LMP started on February 14 then ovulation for that cycle took place on February 1st.

The most accurate method, however, is the ovulation prediction kit. This kit is urine based and requires no painful needle sticks. The ovulation kit works by detecting the luteinizing hormone (LH) surge, which occurs just before ovulation. This is the earliest and most accurate method available for predicting ovulation. Ovulation is governed by elevations in luteinizing hormone, which trigger elevations in Oestrogen, thus causing ovulation. By monitoring elevations in luteinizing hormone, a person can anticipate ovulation even before it occurs.

The Role of the Male
The male partner also plays an important role in fertilisation. In fact, the male factor is the most common cause of infertility, accounting for over 25% of the cases. A semen analysis can assess the sperm for quality and quantity. It is a simple, non-invasive procedure, which analyses the semen for sperm concentration, sperm motility, sperm morphology and various other parameters listed below.

Normal parameters:
Volume – 2-5 ml
Ph- 7.2 –7.8
Sperm Concentration – 20M/ml
Sperm Motility- >50%
Sperm Morphology- >50%
WBC- <1 Million wbc/ul
(Adopted from the World Health Organisation)

Sperm health can be compromised by medical conditions, substance abuse, and environmental factors. Medical conditions such as Kartagener’s syndrome, a relatively rare disease, which affects the heart, can lead to azopermia. Azopermia means the inability to produce sperm.

As far as environmental conditions are concerned, sperm are extremely heat sensitive. They require a basal temperature that is a few degrees cooler the normal body temperature. In extremely hot conditions, such as hot spas and wearing tight undergarments, the sperm can denature and affect ones’ ability to conceive.

At the end of the day, fertility is a process that is affected by both sexes. By maintaining a healthy lifestyle and being in tune with the body’s subtle changes, one can greatly increase the probability of conceiving.

If you’re extremely tuned in to your body’s rhythms, you may begin to suspect you’re pregnant soon after conception. But most women won’t experience any early pregnancy symptoms until the fertilised egg attaches itself to the uterine wall, several days after conception. Others may notice no signs of pregnancy for weeks and begin to wonder “Am I pregnant?” only when they miss a period. Below is a list of some of the first signs of impending motherhood. You may experience all, some, or none of these symptoms of pregnancy:

1. Altered sense of taste. You may notice that your sense of taste changes. Some women say they have a metallic taste in their mouth, others that they cannot stand the taste of coffee, tea, or a food they usually like.

2. Food cravings. Yes, it’s a cliché, but food cravings sometimes can be a sign of pregnancy. Don’t rely on them as a sure symptom (it may be all in your head, or even a sign that your body is low on a particular nutrient), but if cravings are accompanied by some of the other symptoms on this list, start counting the days from your last period.

3. Frequent urination. Once the embryo implants and begins producing the hormone human chorionic gonadotropin (hCG), you may find yourself going to the bathroom more often.

4. Implantation bleeding or cramping. About eight days after ovulation, you may experience implantation spotting, a slight staining of a pink or brown colour, as well as some cramping. This is caused by the egg burrowing into the endometrial lining. You might also see some spotting around the time you expect your period.

5. Darkening of your areolas. If the skin around your nipples gets darker, you may have successfully conceived, though this may also signal a hormonal imbalance unrelated to pregnancy or be a leftover effect from a previous pregnancy.

6. Tender, swollen breasts. If you’re pregnant, your breasts will probably become increasingly tender to the touch, similar to the way they feel before your period, only more so. Once your body grows accustomed to the hormone surge, the pain will subside.

7. Fatigue. Feeling tired or even exhausted? High levels of the hormone progesterone can make you feel as if you’ve run a marathon when all you’ve done is put in a day at the office. Fatigue is a hallmark of early pregnancy, though probably not a surefire symptom on its own!

8. Morning sickness. If you’re lucky, morning sickness won’t hit you until a few weeks after conception. (A lucky few escape it altogether.) But as early as a couple of days following conception, you may begin feeling nauseated and queasy. And not just in the morning, either — pregnancy-related nausea can be a problem morning, noon, or night.

9. A missed period. If you’re usually pretty regular and your period is late, it’s worth trying a pregnancy test. A missed period is the surest sign of pregnancy in a woman of childbearing age who usually has regular periods.

And finally…

10. A positive home pregnancy test. If you’ve waited to test until at least the first day of a missed period and a blue line appears in the test window, you’re most likely to be, well, pregnant! Make an appointment with your doctor to confirm the good news, and head over to our pregnancy area. Congratulations!

Conception Tips For Men

Try and wear loose boxers or underwear, do light exercises, avoid junk foods and smoking and limit alcohol intake. All the above can influence and decrease sperm quality and sperm count, when you want to increase sperm count. Male fertility can be affected by many things but you need to see a doctor to confirm that everything is working fine.

Conception Tips For Women

Female fertility is a different and more complex topic. Polycistic Ovarian Syndrome PCOS is a condition which can affect you having baby, it certainly does not mean you suffer from female infertility. When improving your chances to conceive try a healthy diet, avoid alcohol & smoking as they are harmful to your baby and can be a barrier to getting pregnant. Take Folic Acid to prevent spina bifida.

Remember, “how to conceive” is a difficult question to answer as there are so many features involved to getting pregnant quickly. However, as a start, the factors vital for conception include:

• Adequate and viral sperm from the male partner
• Appropriate frequency of sexual intercourse around the woman’s ovulation time
• Optimally free passageway for the eggs to travel down the fallopian tube, meet with sperm coming up the tube and then fertilization
• Appropriate and timely transportation of the product of fertilization down to the uterus for implantation and development
• Adequately free passageway for the sperm to get through the cervix into the uterus, so they can swim up into the fallopian tube to meet and fertilize the female egg
• Healthy and sound uterine cavity with adequate uterine lining conducive to implantation and development of the pregnancy

In evaluating infertility, therefore, or in assessing a couple’s chances at conception, we can sub divide the factors vital for achieving conception as thus:

Male Factor (Sperm count and quality)

The male factor accounts for 40-50% of infertility problems. Out of this amount only about 10-20% of men have no mature, motile sperm at all (azoospermia). The others only happen to have low counts or a fewer number of normal shaped, mature and motile sperm cells compared to other fertile men. In normal conditions, an absolute sperm count of 16 million is perfect, while a count of less than 5 million almost always result in sterility. Counts between 5 and 16 can in most cases be overcome with infertility treatments.

Ovarian Factor (ovulation frequency and regularity)

Women who do not produce eggs each month or those who only produce eggs every 2-3 months will have problems getting pregnant. The most common causes of annovulation (menses without ovulation) or irregular menses are; Polycystic Ovarian syndrome (PCOS), a condition where follices mature, but the eggs are arrested and not released and Hypothalamic Amenorrhea, which is like a stress or medication induced lack of ovulation. There are other medical conditions that can cause lack of ovulation, but these occur only in rare occasions. Ovarian factor problems are usually treated with fertility pills (e.g. clomiphene citrate) or medications like gonadotropins.

Intercourse Around Ovulation Time

Women with a regular menstrual cycle can always predict their ovulation time. Ovulation occurs midway between the onset of the last menses and the beginning of the next one. Even for women with an irregular menstrual cycle, there are several ovulation predictions kits out there that can provide clues as to when your ovulation occurs. Intercourse should be more frequent around this period, with a frequency of at least, every other day. Therefore, for a 28 day cycle, ovulation will probably occur on day 14, days 11, 13, 15 and 17 should not be missed.

Tubal Factor (free and clear passage to egg and sperm)

The fallopian tubes also constitute a vital actor in conception. The tubes must be free and clear to sweep up eggs that have been ovulated, free and no obstruction to the passage of egg and sperm. Fertilization takes place in the tubes and it is also important that the tubes transport the product of fertilization to the uterine cavity on time for implantation and growth. Pelvic surgery, past ruptured ovarian cyst, past pelvic infections and endometriosis are all conditions that can affect the ability of the tube to sweep up ovulated egg. PID can also produce scarring inside the tube that prevents passageway for ovum.

Uterine Factor

The uterus is the final home of the fertilized ovum and where implantation and growth to full term occurs. Any condition that affects or alters the amount of space or shape of the surface area inside the uterus or disturbs the hormonal sequence that prepares the lining of the uterus for conception may impair fertility. Conditions like fibroids, polyps, congenital anomalies of the uterus or past scarring due to surgery or infection will alter the shape and surface area of the endometrium and in turn fertility. Also, malfunctioning of the corpus luteum may hormonally retard the lining of the uterus and its readiness for implantation.

Cervical Factor (clear passage to sperm from the vagina)

Cervical Factor. Under most conditions, the cervix does not constitute a factor in infertility, except when the cervical mucous glands have been destroyed during some procedures like Cervical Cryosurgery, conization LEEP etc. The cervical mucous glands act as a storage for sperm cells, so they can ’shower’ the uterus and the uterine tube with sperms in order not to miss ovulation. The frequency of intercourse may need to be increased to achieve conception if these glands have been destroyed.